Michigan

A UVC light flashes as it cleans a room at CS Mott Children's Hospital. The light is part of a pilot program to enhance the cleaning hospital rooms to prevent infections.
(Melanie Maxwell | The Ann Arbor News file photo)

Even in the best hospitals, health care-associated infections occur far more frequently than we’d like to believe.

Leading infection preventionists at Ann Arbor area hospitals say the public’s demand for more transparency about these infections have pressed them into a spotlight that can be both beneficial and uncomfortable.

“The increased attention on the issue has been nothing but good for us and good for our patients, it helps us be motivated to improve,” University of Michigan Health System chief medical officer Dr. Skip Campbell said.

Diseases that can be contracted in hospitals include surgical site infections, catheter associated urinary tract infections and central line-associated blood stream infections as well as anti-bacteria resistant infections like MRSA and C. diff.

The University of Michigan Health System, St. Joseph Mercy Health System and Chelsea Community Hospital all said that they voluntarily submit information on these infections to the Michigan Health and Hospital Association which aggregates the data into its Keystone Center which releases aggregate data while keeping hospitals anonymous.

The three hospitals also provide information to the Centers for Medicare and Medicaid Services which publishes the data in its Hospital Compare website. The VA Ann Arbor Healthcare System said in a statement that it does not report to the National Healthcare Safety Network but does report specific HAIs to the VA Inpatient Evaluation Center. The hospital also reports communicable diseases by individual case to the Michigan Disease Surveillance System.

University of Michigan managing director of infection control and epidemiology Lisa Sturm said that the emphasis being placed on the infections at a federal level is having a direct impact on the attention being paid to the issue at hospitals across the country. She said that a new pool of money is being created to give bonuses and incentivize hospitals to lower their HAI rates.

Managing director of Infection Control & Epidemiology, Lisa Sturm said she has seen an increased focus on infection prevention over the past few years at the University of Michigan's hospitals.Melanie Maxwell | The Ann Arbor News

Sturm said that the possibility of making money by keeping infection rates down has helped catch the attention of higher-level hospital exectutives and make prevention and control more of a priority.

“When looking at an institution’s attention for a program, you go up logarithmically in importance when you’re a value add instead of a risk,” she said.

St. Joseph Mercy director of infection prevention and control Russ Olmstead said that while attention to infection prevention has picked up over the past few years, it started in earnest in 1999 after the publication of a report by the Institute of Medicine called “To Err is Human.”

“It was aimed at the broad array of complications that can happen to patients in the hospital,” Olmstead said.

“It was really a wakeup call to providers and health care personnel and that we really need to try to do our best to avoid not only infections but other complications as well.”

Efforts to cut down infection rates have led local hospitals to grow and diversify their infection prevention teams. Both UMHS and the Trinity hospitals said that their infection teams include a range of nurses, epidemiologists and clinical microbiologists.

“It’s a combined effort and with this growing interest by consumers in data, managing that data increasingly points to the need for people with the skills to look at large data sets and come out with the information,” Olmstead said.

Coming out with the information and presenting it in a way that is digestible by laypeople has proven to be a challenge for hospital epidemiologists and administrators. Every hospital official interviewed expressed skepticism that the general public would be able to use the data available to compare hospitals without significant help from experts.

“It’s a double edged sword,” Sturm said. “You want it out there and it does raise awareness, but it’s always to be taken with a grain of salt because comparing numbers can be tricky and requires some degree of expertise.”

Russ Olmstead, St. Joseph Mercy Hospital director of infection prevention and control, said he'd like to see a statewide panel convened to figure out how to get more information into the hands of consumers.Courtesy St. Joseph Mercy Hospital

Olmstead said he would like to see a statewide advisory panel convened that would include patient advocates, insurance companies and health care providers that would come up with a plan to provide more data to patients. He said that many of the hospitals that already provide the data to the Centers for Medicare and Medicaid and the Centers for Disease Control and Prevention would be able to simply “flip a switch” and provide the data to the new site as well.

Campbell said he thinks all hospitals should report their infection data and that the information should be made widely available to the public.

“That’s why we made [our] transparency website, put a lot of money and time into that thing,” he said.

“An asterisk there is we want to present it with information about what it means, and what are the limitations of looking at it like that.”

“Bear in mind, in a lot of ways it’s cherry-picked data. You’re not going to put out there voluntarily that you have a 30 percent infection rate in X. You’re just not, it’s bad for business,” she said.

Campbell said that showing both good and bad data is important, and noted that a number of data points on the website show areas where U-M needs to improve to meet CDC standards.

“People don’t expect you to be perfect, but if you are struggling they want to know that you’ve identified the weakness and what you’re doing about that,” he said.

Hospitals in the area have been working to address their weaknesses with new procedures designed to ensure cleanliness and sterility in hospital environments. The use of tools as simple as checklists have helped decrease infection rates at hospitals across the country.

“Just like you wouldn’t want the airplane to take off until you’re sure everything works, you don’t want people putting in an IV until they’ve made sure they washed their hands and put on gloves and made sure the site that the IV is going in is clean,” Betsy Foxman, a University of Michigan School of Public Health epidemiology professor, said.

“It’s quite impressive what you can do with the checklist. It costs money to develop and then train people, but on the flip side it saves a lot of money and in terms of morbidity and your time in the hospital quality of life all of those issues.”

In addition to his duties at the U-M Health System, Campbell also leads the Michigan Surgical Quality Collaborative, an organization that he said is dedicated to spreading these types of best-practices between hospitals across the state.

“One of the reasons we haven’t made a as much progress as we could have is good ideas tend to get stuck in individual hospitals,” he said.

“I think the more networks that a hospital can be involved in where you look at best practices and data, that’s really healthy and we should be doing that. That’s how you get best practices out into every hospital.”

The University of Michigan also recently invested in a pilot program to use ultraviolent light to kill bacteria in rooms between patients. Environmental services training coordinator James Becker said that the system is currently cleaning approximately 25 rooms per day.

“It’s in the pilot phase now, we’re testing it out,” he said.

“If it’s going to do the trick we’re going for it. If it prevents even one patient from getting C. diff or MRSA it will be worth the investment for us.”

Olmstead said that efforts to reduce HAIs at Trinity hospitals also include checklists, increased sterilization techniques and further dedication to following procedures. All infection preventionists interviewed in the area said that while hospitals compete for patients, they have a common aim.

“Our goal is to eliminate them [HAIs],” Olmstead said.

“With some types of infections it’s a lot more difficult, but it’s still a good goal to set. We’re all working toward zero as much as we can.”

Ben Freed is a general assignments reporter for The Ann Arbor News. Email him at benfreed@mlive.com and follow him on twitter at @BFreedinA2. He also answers the phone at 734-623-2528.